<h2><tmpl_var name="list_head_txt"></h2>
<p><tmpl_var name="list_desc_txt"></p>

<div class="panel panel_client">

  <div class="pnl_formsarea">
    <fieldset class="inlineLabels"><legend>Address</legend>
      <div class="ctrlHolder">
      	<label for="company_name">{tmpl_var name='company_name_txt'}</label>
        <input name="company_name" id="company_name" value="{tmpl_var name='company_name'}" size="30" maxlength="255" type="text" class="textInput" />
	  </div>
      <div class="ctrlHolder">
      	<label for="contact_name">{tmpl_var name='contact_name_txt'}*</label>
        <input name="contact_name" id="contact_name" value="{tmpl_var name='contact_name'}" size="30" maxlength="255" type="text" class="textInput" />
			</div>
	  <div class="ctrlHolder">
      	<label for="customer_no">{tmpl_var name='customer_no_txt'}</label>
        <input name="customer_no" id="customer_no" value="{tmpl_var name='customer_no'}" size="30" maxlength="255" type="text" class="textInput" />
	  </div>
      <div class="ctrlHolder">
      	<label for="username">{tmpl_var name='username_txt'}*</label>
        <input name="username" id="username" value="{tmpl_var name='username'}" size="30" maxlength="255" type="text" class="textInput" />
			</div>
      <div class="ctrlHolder">
      	<label for="password">{tmpl_var name='password_txt'}</label>
        <input name="password" id="password" value="{tmpl_var name='password'}" size="30" maxlength="255" type="password" class="textInput" onkeyup="pass_check(this.value)" />
			</div>
      <div class="ctrlHolder">
				<p class="label">{tmpl_var name='password_strength_txt'}</p>
				<div id="passBar"></div>
				<p class="formHint"><span id="passText">&nbsp;</span></p>
			</div>
      <div class="ctrlHolder">
      	<label for="language">{tmpl_var name='language_txt'}</label>
        <select name="language" id="language" class="selectInput withicons">
					{tmpl_var name='language'}
				</select>
      </div>
      <div class="ctrlHolder">
      	<label for="usertheme">{tmpl_var name='usertheme_txt'}</label>
        <select name="usertheme" id="usertheme" class="selectInput">
					{tmpl_var name='usertheme'}
				</select>
      </div>
      <div class="ctrlHolder">
      	<label for="street">{tmpl_var name='street_txt'}</label>
        <input name="street" id="street" value="{tmpl_var name='street'}" size="30" maxlength="255" type="text" class="textInput" />
			</div>
      <div class="ctrlHolder">
      	<label for="zip">{tmpl_var name='zip_txt'}</label>
        <input name="zip" id="zip" value="{tmpl_var name='zip'}" size="10" maxlength="255" type="text" class="textInput" />
			</div>
      <div class="ctrlHolder">
      	<label for="city">{tmpl_var name='city_txt'}</label>
        <input name="city" id="city" value="{tmpl_var name='city'}" size="30" maxlength="255" type="text" class="textInput" />
			</div>
      <div class="ctrlHolder">
      	<label for="state">{tmpl_var name='state_txt'}</label>
        <input name="state" id="state" value="{tmpl_var name='state'}" size="30" maxlength="255" type="text" class="textInput" />
			</div>
      <div class="ctrlHolder">
      	<label for="country">{tmpl_var name='country_txt'}</label>
        <select name="country" id="country" class="selectInput withicons">
					{tmpl_var name='country'}
				</select>
      </div>
      <div class="ctrlHolder">
      	<label for="telephone">{tmpl_var name='telephone_txt'}</label>
        <input name="telephone" id="telephone" value="{tmpl_var name='telephone'}" size="30" maxlength="255" type="text" class="textInput" />
			</div>
      <div class="ctrlHolder">
      	<label for="mobile">{tmpl_var name='mobile_txt'}</label>
        <input name="mobile" id="mobile" value="{tmpl_var name='mobile'}" size="30" maxlength="255" type="text" class="textInput" />
			</div>
      <div class="ctrlHolder">
      	<label for="fax">{tmpl_var name='fax_txt'}</label>
        <input name="fax" id="fax" value="{tmpl_var name='fax'}" size="30" maxlength="255" type="text" class="textInput" />
			</div>
      <div class="ctrlHolder">
      	<label for="email">{tmpl_var name='email_txt'}</label>
        <input name="email" id="email" value="{tmpl_var name='email'}" size="30" maxlength="255" type="text" class="textInput" />
			</div>
      <div class="ctrlHolder">
      	<label for="internet">{tmpl_var name='internet_txt'}</label>
        <input name="internet" id="internet" value="{tmpl_var name='internet'}" size="30" maxlength="255" type="text" class="textInput" />
			</div>
      <div class="ctrlHolder">
      	<label for="icq">{tmpl_var name='icq_txt'}</label>
        <input name="icq" id="icq" value="{tmpl_var name='icq'}" size="30" maxlength="255" type="text" class="textInput" />
			</div>
	  <div class="ctrlHolder">
      	<label for="vat_id">{tmpl_var name='vat_id_txt'}</label>
        <input name="vat_id" id="vat_id" value="{tmpl_var name='vat_id'}" size="30" maxlength="255" type="text" class="textInput" />
	  </div>
      <div class="ctrlHolder">
      	<label for="notes">{tmpl_var name='notes_txt'}</label>
        <textarea name="notes" id="notes" rows='10' cols='30'>{tmpl_var name='notes'}</textarea>
      </div>
	  {tmpl_var name='required_fields_txt'}
    </fieldset>

    <input type="hidden" name="id" value="{tmpl_var name='id'}">

    <div class="buttonHolder buttons">
      <button class="positive iconstxt icoPositive" type="button" value="{tmpl_var name='btn_save_txt'}" onClick="submitForm('pageForm','client/client_edit.php');"><span>{tmpl_var name='btn_save_txt'}</span></button>
      <button class="negative iconstxt icoNegative" type="button" value="{tmpl_var name='btn_cancel_txt'}" onClick="loadContent('client/client_list.php');"><span>{tmpl_var name='btn_cancel_txt'}</span></button>
    </div>
  </div>
  
</div>
